Today the ESRC has launched a new multi-million pound initiative which aims to expand understanding of how the behaviour of professionals, organisations and the public impacts on anti-microbial resistance (AMR) – particularly resistance to antibiotics and other drugs.

The new call is part of the wider cross-research council initiative on AMR. The ESRC is looking for academics, from across the social and medical sciences and the arts and humanities, to lead collaborative research on how we can enhance or control the spread of AMR.

Anti-microbial resistance (AMR) is a ‘wicked problem’ which leads to drug resistant infections. The evidence is incomplete or contradictory, there are many different interest groups with different needs and views, and the ‘solution’ depends on how the ‘problem’ is framed and vice versa. Like other ‘wicked problems’ (eg climate change, species conservation, pandemic influenza) that result from the complex interaction of a huge range of influences, there is no single, simple solution and so our response needs to be multifaceted.

Leonardo Da Vinci excelled in different artistic and scientific fields long before we had separated these activities out into the numerous disciplines we have today. This boundary-crossing approach is what is called for by the cross-research council initiative to tackle antimicrobial resistance.

This ‘inter-disciplinary’ research (as it is known) is essential “to solve the grand challenges facing society”. The cross-Council initiative is a rare call for everyone from artists to veterinary scientists to work together on the problem of AMR.

The O’Neill Review

So far, a lot of attention has focused on possible technological solutions (such as new antibiotics and rapid diagnostic tests), but key work by the O’Neill Review team has rightly highlighted the importance of understanding economic processes. These underline the ‘wicked’ nature of this problem, as the needs and views of stakeholders are not aligned. Pharmaceutical companies want to maximise profits, but governments want to restrict the use of new antibiotics to preserve their effectiveness – so the pharmaceutical industry cannot recoup the costs of developing them through sales. The O’Neill Review recommends other financial mechanisms to encourage the industry to develop new drugs that can be reserved for use when current ‘last resort’ antibiotics become ineffective.
When, how and why people use existing antibiotics unnecessarily

Improving the likelihood of future technological innovations can only ever be part of a solution. When, how and why people use existing antibiotics – for themselves or their animals – are questions that can’t be tackled through drug or diagnostics development. For many people around the world, especially in lower and middle income countries, the problem is not so much too many antibiotics as insufficient access to them. The tension between access and excess is another dimension of the ‘wickedness’ of the problem; seemingly obvious solutions, like banning over-the-counter antibiotics sales in low-income countries, risk denying essential life-saving drugs to the poor, who lack easy access to decent medical care where they can be prescribed appropriate antibiotics when needed. Here social science is needed to understand the complexities of human behaviour and the cultural, social, institutional and political forces that shape it, as well as individual psychology. This way we can gain insights into ways to ensure that people get access to these life-saving drugs when they need them, while not using them unnecessarily so that infections become resistant to them.

Behaviour within and beyond the health care setting – the questions being asked across science

We come back to the ‘wicked’ nature of the issue. The way the ‘problem’ is framed is important to how we tackle it: excessive use, or lack of access; public demand, or market-led health systems that incentivise medical practitioners to overprescribe; international travel, or locally occurring ‘pockets’ of resistance; lack of incentives for commercial pharmaceutical production or lack of non-profit-making alternatives for developing new drugs; medical/veterinary overuse, or environmental contamination?

Opportunity

The Theme 4 call is an opportunity for truly interdisciplinary research involving veterinary, medical and social scientists, clinicians and humanities researchers. Thinking and acting collaboratively is perhaps the only way we might truly be able to tackle this wickedly complex problem.

Yes! We need to look beyond the “use antibiotic only when necessary” rhetoric and explore the societal factors that underscore antibiotic misuse. It’s not only middle or lower income countries. In Canada, people are using antibiotics without prescription because sick leave is quite dangerous for certain jobs and it is better in the short-term to take an antibiotic ‘just in case.’ Knowledge alone will not change these behaviors.

The way we frame antibiotic resistance as a “war” or a “doomsday scenario” might also be problematic because it dumbs down “wicked” nature of the problem, causing us to focus on finding a technological solution while ignoring other solutions such as improving physician-patient communication (physicians frequently over-estimate the number of patients expecting antibiotic). Worse, we might encourage people to play the “blame game.”

I hope through this initiative, we could improve how we communicate antibiotic resistance to the public and stakeholders. Best wishes from Canada!